The DSM-5 Says Kink is OK!

The American Psychiatric Association has depathologized kinky sex – including cross-dressing, fetishes, and BDSM – in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Now the paraphilias are considered to be “unusual sexual interests,” while those who have sex with children or people who haven’t consented, or who deliberately cause harm to themselves or others, may be diagnosed with a Paraphilic Disorder.

“The APA has made it clear that being kinky is not a mental disorder,” says Susan Wright, Spokesperson for NCSF. “That means people no longer have to fear being diagnosed as mentally ill just because they belong to a BDSM group. We’ve already seen the impact – NCSF immediately saw a sharp rise in the success rate of child custody cases for kinky parents after the proposed DSM-5 criteria was released three years ago.”

NCSF would like to thank everyone who participated in signing our DSM Revision Petition and for telling the APA about their own stories of discrimination and persecution. NCSF also thanks every member of the APA Paraphilias Subworkgroup for responding to our concerns, and drawing a hard line between consensual adult kinky sex and those who willfully engage in nonconsensual or harmful activities.

NCSF is proud to build on the work of kink-aware professionals who have come before us, including Race Bannon and Guy Baldwin, who helped make seminal changes in the DSM-IV in 1994.

The following are some statements about the various paraphilias in the DSM-5. Although highly clinical in language, they show the APA’s intent to not demand treatment for healthy consenting adult sexual expression:

“A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.” p. 686

“In contrast, if they declare no distress, exemplified by anxiety, obsessions, guilt or shame, about these paraphilic impulses, and are not hampered by them in pursuing other personal goals, they could be ascertained as having masochistic sexual interest but should not be diagnosed with a sexual masochism disorder.” p. 694

“Many individuals who self-identify as fetishist practitioners do not necessarily report clinical impairment in association with their fetish-associated behaviors. Such individuals could be considered as having a fetish but not fetishistic disorder.” p. 701

“Clinical assessment of distress or impairment, like clinical assessment of transvestic sexual arousal, is usually dependent on the individual’s self-report.” p. 703

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Normal or Not? A Sexual Attraction to Objects

The DSM-5 marks this transition by attaching the term "disorder" when an unusual sexual interest crosses these boundaries. So, hypothetically, someone who simply uses shoes to masturbate or whose partner accepts his unusual interest in shoes could be diagnosed with fetishism, but not a fetishistic disorder — unless the fetish crosses the threshold in one of the ways described above.

Along the same lines, Wismeijer also suggested that accepting one's unusual sexual preferences and choosing to live in a societal niche like the BDSM community might involve huge amounts of psychological work, which could translate into positive mental health.